At Work With: Ted Tanaka, Doctor of Podiatric Medicine

At Ted Tanaka's podiatry office, the waiting room is noticeably
absent of patients fidgeting in their seats or thumbing through
magazines. "It a patient has an appointment at 3 pm. then that
person is seen at 3 p.m." he says, noting he doesn't like to keep
anyone waiting and will see fewer patients in a day than many
doctors so he can devote more time to them. His attitude of putting
patients first is clear as he talks about keeping feet healthy,
the challenge of opening his own practice and the growing need for
podiatrists, "You have to reaIly care about the patient. It's not
just a foot that you're treating. it's a person."

What's the scope of your work as a podiatrist?

I evaluate and treat disorders of the foot and ankle. That
includes musculoskeletal, dermatological and neurovascular problems
that can be treated both non-surgically and surgically.

What are some of the ailments you treat?

Plantar fasciitis is one of the most common problems I see in the office.

In fact, it seems like this condition is more prevalent today
than when I started 20 years ago, probably because there are more
exercise fanatics. Bunion and hammertoe deformities are also common,
as are ingrown toenails. I've even treated infants with ingrown
toenails. Many patients also come into my office complaining of
collapsed arches or flat feet, which can lead to shin splints.

Dermatology problems such as fungal nails, athletes' feet,
staph and strep infections are treated on a daily basis.

Do a person's feet reflect their overall health?

A lot of times yes. I see many patients who tell me, "When your
feet hurt, your whole body hurts." Some of them come in depressed
because their feet hurt so much they don't want to get out of
bed. Making them feel better changes their mental and physical
outlook. It's important for people to take care of their feet
— especially diabetics who can develop poor sensation and
circulation problems.

For women, it's hard to escape wearing high
heels. Are they really that bad for the feet?

Well, you know the answer to that [laughs]. When you raise your
heels more than two inches off the ground, the biomechanics of
the whole body dramatically change. You force more weight on the
balls of your feet, which adds more pressure onto joints and
nerves and then changes the pull of the tendons and muscles.
Wearing high heels continually over a matter of years can actually
cause the calf muscle to shorten and tighten, which can cause arch
cramps. achilles tendonitis and knee and hip joint pain. The
back can become tired and sore because your muscles will try
to keep you in balance.

So you would say don't wear them?

Not higher than two inches. They look nice, but they aren't
very functional. They're made purely for cosmetic reasons — not long walks.

Take me through an average week.

I currently work three and a half days in my office and devote
Friday mornings to surgery cases. I see 20-25 patients on a full
day. I see patients one at a time and they truly appreciate the
time I spend with them. If a patient has an appointment at 3 pm
then that person is seen at 3 pm.

The nice thing about this practice is that my wife Pam works
with me as the office manager so she can control the pace and
volume of patients. And we can build in time to see our
daughter's soccer games and music concerts.

What was it like starting your own practice?

It was very difficult when I first started. Luckily, I met an
older podiatrist and worked in his office for a short time and when
he retired he sold me the practice. That's probably the best way to
start because you already have a steady flow of patients. You wouldn't
have the same luxury if you opened up a practice on your own.

Another challenge while starting out was getting on staff at
local hospitals where I could perform most of my major foot
surgeries. My surgery cases are done at the Alta Bates Summit
Medical Center, Doctors Medical Center in San Pablo and Canyon
Pinole Surgery Center in Pinole. It also helps to be a contracted
provider for all the insurance plans and HMO medical groups.

What was your schooling?

From 1982 to 1986, I attended the California School of Podiatric
Medicine in San Francisco, which has since moved to [Alta Bates]
Summit Medical center in Oakland. I also did a two-year foot and
ankle surgical residency in Hayward.

I did my undergraduate work at UC Davis and majored in health
services. My first thought was to go into hospital administration
until I did an internship at Davis Community Hospital. The
administrator there was around 30 and had hair that was completely
white from stress. So I changed direction and ended up becoming a
physician's assistant, working at various medical clinics before
embarking on a career in podiatric medicine.

What piqued your interest in the profession?

I am a big sports enthusiast so the idea of treating athletes
was one of the reasons why I went into podiatry. Podiatric sports
medicine has been a major part of my practice. I treat a lot of
competitive athletes, including soccer and basketball players
and runners.

Why are podiatry schools separate from medical schools?

Podiatry schools started out as independent schools almost 100
years ago and are still independent specialty colleges. But, as
with medical school, the curriculum consists of the basic sciences
— biochemistry, physiology, neurology, microbiology and anatomy
— and students have didactic courses and clinical rotations.

What's your advice to someone who may be interested in podiatry?

As more baby boomers age and life expectancy increases, there will
be a greater demand for podiatrists. The unfortunate thing is that
enrollment at the California School of Podiatric Medicine is now half
of what it was when I was in school 20 years ago, which means there
is going to be a shortage. If you have an interest in this profession,
contact the podiatry school, talk to students and professors and
also with podiatrists in your neighborhood.

How much could someone here make as a podatrist?

After 10 years in practice, the average could be around $250,000 to $350,000.

What's the key to being a good podiatrist?

As with any medical profession, you need to have good listening
skills to be a good problem solver. You would need to make a mental
list of all the signs and symptoms and all possible diagnoses related
to the problem. For example, if a patient complains of heel pain,
you have to think of every musculoskeletal, dermatory vascular or
neurological condition that could cause the pain in that problem
area. I've had patients who have foot pain because of a blood clot
in their leg. Look at the patient as a person and don't just focus
on their feet.